News Paper Article - December 15, 2002

"Drug firms and doctors: the offers pour in."

What has happened to the medical vocation? Why do some doctors (MD’S) often slackly prescribe prescription drugs without care and will not provide the patient with information for risk-free and effective natural products?

The following segments were taken from an article in the Boston Globe Which ran December 15, 2002:

Drug firms and doctors: the offers pour in.

During the past six months, Dr. Eugene Fierman and his two colleagues were showered with offers worth thousands of dollars.

At least once a week, the nation’s pharmaceutical firms invited them for “educational evenings” at some of the city’s priciest restaurants, including cocktail and dinner at Radius paid for by Pfizer, an insomnia discussion at Locke-Ober, and a depression talk at Maison Robert – both on Wyeth’s tab.

Some pharmaceutical companies wanted to hire them as temporary advisers, including Forest Pharmaceuticals, which promised the doctors $500 each for listening to a Saturday morning talk about the firm’s new antidepressant, Lexapro, at a Cambridge hotel and then providing “advice and feedback.”

And occasionally drug company employees dropped off at the doctor’s rented office at Faulkner Hospital small gifts: a box of cookies from the Wyeth salesman, four classical CD’s from the Pfizer representative.

With investigations into the industry’s sales tactics growing, and a new voluntary code of conduct in place that stresses educating rather than entertaining doctors, Fierman, Dr. Ann Potter, and Dr. Gregory Harris – like many of their colleagues throughout the medical profession – said sales representatives now rarely offer the most lavish gifts that were routine in past years: theater tickets, golf trips, and resort weekends.

Instead, drug makers are paying for or offering more “consulting opportunities”, even for one evening, continuing medical education courses, and dinners billed as “educational events” with specialist speakers. At the Globe’s request, the three doctors kept track of pharmaceutical-related invitations and offers they received over a five-month period. The material was enough to overflow a 1-foot-square, 2-foot-high box.

“It’s hard to resist all this money and free stuff FL oating around,” said Harris. “But it’s a slippery slope, and I don’t want to be in the position of doing something that crosses the line.”

The shift in the tactics drug companies are using to establish close relationships with doctors was occurring even before the industry adopted the new guidelines in July. The amount of money pharmaceutical firms spent on meetings and events, including continuing medical education, teleconferences, dinners, symposia, and get-togethers with physician advisers, more then doubled over four years to $2.1 billion in 2001, according to Verispan, a company that tracks promotional spending.

Drug makers say these classes and gatherings provide physicians with crucial information about medicines that could help their patients – and allow doctors to speak to each other about their experiences. But Dr. Marcia Angell, former editor of the New England Journal of Medicine, said the danger is that companies simply disguise marketing as education, while slanting presentations toward their own products and helping to increase health-care costs.

“These companies are in the business of selling drugs, period,” Angell said.

Physician leaders also are concerned about what they see as a rise in consulting and question whether doctors are providing meaningful advice to the companies – something required by the new guidelines – or are merely being paid large sums to listen to a sales pitch. And federal law prohibits companies from offering doctors cash inducements to prescribe their drugs. Dr. Sidney Wolfe, director of Public Citizen Health Research Group in Washington, D.C., said some consulting fees have gotten so high that he believes they border on illegal inducements. He has referred several cases to the US inspector general.

With the focus on drug industry marketing intensifying, doctors are increasingly concerned about their interactions with sales reps, and some are taking steps to limit their visits – or keep them out of their offices entirely. But that – Fierman, Harris, and Potter discovered – is not so easy.

“You can’t totally drop out of this crazy system, “ Fierman said.